Aspirin-Sensitive Asthma Linked to Sinus Problems During Menstruation

Patients with aspirin-exacerbated respiratory disease (AERD) and perimenstrual asthma often report an associated increase in sinus symptoms during menstruation, according to a recent study published in The Journal of Allergy and Clinical Immunology: In Practice.

Study researchers sought to investigate the prevalence and characteristics of demographic and clinical variables in patients reporting perimenstrual asthma in AERD. Using the Brigham and Women’s Hospital AERD registry, study researchers surveyed 369 patients with physician-confirmed aspirin-sensitive asthma. Patients who developed AERD after menopause were excluded from the study. Of the resulting 322 patients, study researchers compared those with (n=78; answered “yes” when asked if menstruation worsened asthma symptoms) and without (n=244; answered “no” when asked if menstruation worsened asthma symptoms) perimenstrual asthma. 

The development of certain AERD features at a younger age was significantly associated with perimenstrual asthma. Patients with perimenstrual asthma were younger at asthma diagnosis (P =.026), first nonsteroidal anti-inflammatory drug reaction (P <.001), and first nasal polyp diagnosis (P =.042). However, patients with and without perimenstrual asthma did not differ significantly in asthma severity or type of asthma medication used.

Study researchers also found that sinus symptom worsening with menses was significantly associated with perimenstrual asthma (P <.001). Conversely, study researchers saw reported improvements in both asthma (P <.001) and sinus symptoms (P <.001) at menopause. Patients with perimenstrual asthma also reported more visits to emergency departments (P <.001) and had more hospital admissions (P =.045) than AERD patients without the issue. 

Limitations of the study included the use of self-reported data and possible recall bias, as well as a lack of “objective evaluation of asthma and sinus symptoms.” 

The study researchers confirmed that women with AERD frequently report perimenstrual asthma and noted that this study is the first to describe perimenstrual worsening of sinus symptoms linked to perimenstrual asthma. They stated, “clinicians need to be aware that the overlap of [perimenstrual asthma] and AERD represents a population at risk for healthcare utilization.” Study researchers concluded that although additional research into the pathophysiology of perimenstrual asthma and AERD is needed, women with asthma who report “aspirin intolerance should be counseled about asthma and sinus symptom worsening in relationship to menstruation.”

Reference

Eid RC, Palumbo ML, Cahill KN. Perimenstrual asthma in aspirin-exacerbated respiratory disease [published online September 30, 2019]. J Allergy Clin Immunol Pract. doi: 10.1016/j.jaip.2019.08.054